Provider Demographics
NPI:1043428816
Name:FAX, DANIEL JOSIAH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSIAH
Last Name:FAX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-3733
Mailing Address - Fax:330-543-3270
Practice Address - Street 1:8054 DARROW RD STE 3
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2381
Practice Address - Country:US
Practice Address - Phone:330-425-3344
Practice Address - Fax:330-425-8847
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010706208000000X
OH35.091227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2825385Medicaid
OH2825385Medicaid
OHFA4237672Medicare PIN